Bullying and ASD

Being the victim of a childhood bully can have a lasting impact, including depression and diminished socioeconomic status, into adulthood. 1,2,3Many adults who were once victims of bullying vividly recall the feelings of intimidation, the sometimes-daily battering of self-esteem. Many also recall the hands-off attitude that used to be common among teachers, principals, and other adults. Fortunately, bullying, which was once considered a normal and unavoidable part of the schoolyard landscape, is now viewed as a much more serious matter.

The issue of bullying may be particularly worrisome for parents of children with an autism spectrum disorder (ASD). In this article, we will explore how children with ASD are particularly at risk of becoming victims of bullying. We will also discuss how they may act out in a way that leads to their being identified as bullies. In either case, parents, teachers, and school staff need to know how to help them through the difficulties involved.

What Is Bullying?

Bullying can take many forms. It can be verbal, involving threats or derogatory remarks. It can be physical or behavioral, as when a bully hits, pushes, steals a victim's lunch, or holds his nose every time the victim enters a room. It can also be relational, as when a child is deliberately excluded from social events, or vicious rumors about a child are intentionally spread. It can be conducted in traditional style, on playground, in classroom, and in cafeteria, or via text message and Facebook -- the new and insidious "cyber-bullying."

Virtually every child feels bullied at one time or another, but researchers define bullying as something more than incidental or passing acts of cruelty. Central to the research definition of bullying is that it occurs repeatedly. There also must be a power differential, a situation where the victim is perceived as less physically, psychologically, or socially powerful than the aggressor. 4,5,6Bullying not only damages the victim's self-esteem, but also harms his ability to establish relationships within the peer group.

But bullying can be difficult to put into words. Of course, there are the obvious physical actions or verbal taunts. But what about when classmates get together and decide to boycott a victim's party? Or when a child "befriends" a child who doesn't quite fit in, as a form of social humiliation, smirking and looking around to make sure his friends are watching as his victim fawns all over him in utter gratitude? What about the onlookers? Are they watching, even laughing, because they are bullies, too? Are they perhaps fearful of being targeted, or are they expressing discomfort?

The consequences of allowing bullying to run its course during childhood can be devastating to the individual and the family, as well as to society. School shootings have heightened our awareness of the degree of damage that can result from bullying. Within months of the April 1999 Columbine High School shooting in Littleton, Colorado, the U.S. Secret Service and the U.S. Department of Education launched a study examining 37 school shootings and other violence specifically targeting schools. Among the study's findings: 71% of the attackers, including the two youths who attacked their classmates at Columbine, felt bullied, harassed, or otherwise threatened before the attack. 7A number of other studies have shown a link between being bullied, or bullying, and suicide.8,9As society becomes increasingly aware of the consequences of bullying, schools are developing anti-bullying policies However, bullying often involves activities that remain below the school's radar. A certain degree of conflict can be expected in youth peer groups and, as researchers have noted, "Unless many attackers beat one victim (rare on school grounds), no school disciplinarian can reliably differentiate physical bullying from self-defense, friendly quarrels, and good-natured rough-housing -- none of which requires serious punishment. Since perception is crucial, an identical shove, insult, or brush-off can be inconsequential or devastating; bullies, victims, peers, and adults do not agree." 10

Children with ASD: A Special Case

Bullying and social exclusion are not unusual experiences, particularly for children with medical or developmental issues, 11,12and it is clear that isolated children who lack social skills are at increased risk for bullying. 4,10,13Given this, researchers are now asking whether children with ASD, with their characteristic social deficits, are especially vulnerable. 14,15It is not hard for parents of children on the autism spectrum to imagine the scenarios: their child's inability to "read" the social signs that someone doesn't have her best interest at heart; the eagerness to please that can make him easy to manipulate; the tendency to say what he thinks without a full understanding of consequences. How can a child recognize a potential bully when he lacks the ability to see so many of the clues, the hard edge of mounting frustration or sarcasm in the tone of voice; the smug look of a popular girl asking him out on a date, on a dare; the "friend" who persuades him to unknowingly commit an offense that brings on discipline from the teacher?

"The inability of children with autism to stand up for themselves and the ease with which they can be reduced to tears of rage or frustration by others make them 'perfect victims,'" writes ASD researcher and writer, Patricia Howlin. She adds, "Often they are unclear if they are being bullied, or if what is happening in their own fault...." 16

Because their disability is less obvious, and because they are often placed in mainstream classrooms, children with high-functioning ASD may be at particular risk. In one New York study, parents completed questionnaires about how their children with Asperger syndrome fared with their peers in school. Some reported that their children were "egged on," with one child told to "run like a bull," only to be taunted that he was a freak when he complied; how another child's picture on the bulletin board had the eyes scratched out; how yet another child who had endured prolonged bullying expressed a desire to be "put in the street and run over." 17

A study of special needs children attending regular-education schools in The Netherlands showed that peers were more likely to recognize the imbalance of power and intervene when a classmate with Down syndrome or a physical impairment was targeted by bullies, but were more likely to reject students with behavior problems stemming from pervasive developmental disorder-not otherwise specified (PDD-NOS) and/or attention-deficit hyperactivity disorder (ADHD). 18

In a recent U.S. study of more than 400 children, aged 4 to 17, with Asperger syndrome or nonverbal learning disorder (a disorder involving similar social challenges), mothers reported that 75% of the children had been hit or emotionally bullied by peers or siblings during the previous year. 12Peer shunning, or exclusion from peer activities, also occurred at high rates: A third of the children had not been invited to a birthday party during the previous year, and many ate lunch alone or were the last picked for teams. Overall, these figures -- at least twice as high as the average prevalence of bullying and ostracism reported in national and international studies of the general population of children and adolescents 4,12,19 -- demonstrate the high degree of bullying and isolation many of these children experience.

High-functioning children also may be vulnerable because, despite stereotypes that characterize them as content to be alone, they often do long for friendship. In her book, Perfect Targets: Asperger Syndrome and Bullying, Rebekah Heinrichs writes: "In some instances, they are likely to tolerate a higher level of abuse from their peers in exchange for attention or possible friendship. As one young man with AS stated, 'I'd rather be with kids who aren't nice to me than be alone, ignored, and invisible.'" 20

How Do You Know When Your Child is Being Bullied?

Many children who are bullied do not report it to parents or other adults. 21In addition to this general tendency not to tell, children with ASD may be nonverbal, and so unable to communicate that they are being bullied, or they may have fluent language skills, but be unable to interpret the situation.

Not recognizing genuine bullying can make a child with ASD a likely ongoing victim. Asperger expert Tony Attwood asserts: "Children with Asperger Syndrome have several problems with regard to reporting being a target. They have impaired Theory of Mind abilities; that is, difficulty determining the thoughts and intentions of others in comparison to their peers. They may not intuitively know that the acts of other children are examples of bullying. They can sometimes consider that such behaviour is typical play and something that they have come to accept as yet another confusing behaviour of their peers." 22

To further complicate matters, children with ASD also may have trouble distinguishing bullying from good-natured teasing. When all parties are having fun, it's not bullying, a concept that may be difficult for a child with ASD to grasp. A child who overreacts and bursts into sobs or too easily assumes malicious intent and retaliates may soon be left out of the very "child's play" that might help her learn the skills that will help her fit in. A child who doesn't recognize that the same behavior that was funny only moments ago has turned irritating may prolong a behavior to the point where it provokes others.

There are some signs parents can look for to determine when it may be time to contact the school about potential bullying. Parents of a child with ASD who has become a target may notice that possessions have been lost or damaged, or that clothing has been torn, according to Attwood. They also may notice signs of physical injury, such as bruising, or signs of anxiety, such as stomach aches, problems sleeping, avoidance of school, or other behaviors that may be associated with bullying.

In addition, some children with ASD may respond with aggression when they are targeted by a bully. In the New York study, one parent described her son's eventual response to repeated tormenting from peers on his school bus: "One day, he ran after one of the girls, and then was kicked out of school. Nothing was done to the girl." 17This brings us to our next topic: when a child with ASD is labeled as the bully or aggressor.

When the Child with ASD Is (or Is Viewed as) the Bully

Although individuals with ASD appear more likely to be targets than bullies,23there are some researchers looking into whether the characteristics of ASD also can make these children more prone to becoming bullies. After all, children with ASD are more likely to be boys,24who may be more likely than girls to become bullies, and many of these children require treatment for aggressive behavior or meltdowns,25perhaps putting them at higher risk for being perceived as bullies. In addition, with limited insight into social behavior, adolescents with ASD may bully without being fully aware of the impact they are having, as shown by a recent study of student and teacher perceptions of ASD and bullying. 14They may not recognize that they are acting aggressively or that their behavior is intimidating to others.

A U.S. study of children aged 6 to 17 years did find that children with ASD who also had attention-deficit or attention-deficit hyperactivity disorder were at least four times more likely to bully than typically developing children. 25(This same study found that teens with ASD, but without ADHD, were no more likely to become bullies than typical children.)

Research has also shown that children with behavioral, developmental, or emotional problems are more than three times more likely than typical children to become what is known as a "bully-victim." 11Such a child may lash out when provoked, and end up suspended or otherwise in trouble. Provocation may be intentional, as when a "real" bully goads the child, and then watches with glee as he explodes and gets in trouble. In other cases, a child may be overreacting to innocent, accidental, or ambiguous affronts -- the very misinterpretations one might expect of a child with the social blindness that comes with ASD. 10The bully-victim's aggression is reactive, not coolly planned, desperate, impulsive, and socially clueless, not calculated and manipulative. 26

According to an Australian study of romantic and social functioning in individuals with ASD, adolescents and young adults with ASD may be at risk for stalking behavior. This may result from their tendency to miss social signals of rejection, perhaps causing them to pursue an intimate relationship to the point of being intrusive. The researchers point out the "blurry distinction" between appropriate and inappropriate relationship behaviors, which may leave an individual who has experienced ongoing social rejection with the impression that relationships are possible only with considerable persistence. "Parents reported that it was often difficult for their child to 'understand when to cease persisting in their relationship attempts' and not 'harass the person.' They also reported that their children 'did not believe they were doing anything wrong' and that 'they could not understand why the person was not responding to them as they wanted.'" 27

Parents and school staff need to be aware of the issues that can arise for the student with ASD who is struggling to interpret the social world and make connections with other people. This understanding is especially crucial if the student faces disciplinary action due to his or her behavior toward other students. In the United States, the Individuals with Disabilities Education Act (IDEA) does provide some protection for students with ASD, and a child with an Individualized Education Plan (IEP) is entitled to a "manifestation review" if his or her behavior is about to result in suspension, expulsion, or a change of placement. If such a review demonstrates that the child's conduct "was caused by, or had a direct and substantial relationship to, the child's disability" or "if the conduct in question was the direct result of the local educational agency's failure to implement the IEP," the child must be returned to his school program (unless his or her parents want a new placement) with a new or revised functional behavior program in place. 28,29

A Team Effort

Successful anti-bullying strategies require a team effort from school personnel, early childhood professionals and psychologists, students involved in bullying as targets or aggressors, and child bystanders. 26,30

Perhaps the most crucial first step is to ensure that bullying is not an accepted part of school culture. Old attitudes that viewed it as natural ("boys will be boys"), or easy to contend with ("just ignore it"), or harmless (which research shows it definitely is not) must be replaced. Bullying is harmful to victim and perpetrator alike. As Rebekah Heinrichs writes in "A Whole-School Approach to Bullying": 26

"Outcomes associated with children who bully include substance abuse, eventual negative peer reactions, delinquency and gang involvement, depression, and suicidal ideation. They also have a much greater chance of committing criminal acts as an adult, including domestic violence... Outcomes associated with targets of bullying include anxiety, depression, suicide, withdrawn behaviors, aggression, and physical health problems. As would be expected, children who are both bully and target appear to suffer the most negative consequences."

A code of conduct that specifically defines bullying, and that doesn't limit the definition to physical injury, should be implemented in all educational settings. Teachers and other staff should be trained on how to respond to bullying, while victims, bullies, and bully-victims are provided special social skills training targeting the perceptions, misinterpretations, or interactions that contributed to the bullying in the first place. Making a child less isolated is one crucial piece of this puzzle, perhaps via inclusion in an ongoing support or social skills group, perhaps with other children with ASD. Even child bystanders can be provided with a safe way to report bullying incidents so they can do the right thing without fearing they will make themselves a bully's next target.

What if efforts made by parents, in partnership with a school, fail? What might a parent do? Suggestions include:

Determine if the school is implementing that policy effectively, or at all. Has a lack of tolerance for bullying really been incorporated into the school's culture? Or is the school only paying lip service to a zero tolerance for bullying?

If the policy is not being implemented in an effective way, make an issue of the fact that your child is not able to benefit from his or her education when he or she is being bullied and living in fear. (If necessary, hire an advocate to speak to the school in the language of the law.) In the United States, where the IDEA law guarantees a "free and appropriate public education," you might suggest that having to come to school afraid renders the education the school offers inappropriate.

Don't accept "We didn't see it happen" and "It's that kid's word against his" as excuses for inaction, especially if the conditions remain the same and the same things happen again. If incidents are occurring at the same place and time (during gym, on the playground at recess, in the cafeteria), someone should be assigned to monitor and "catch" the next incident in progress. In fact, one of the main bullying prevention practices Heinrichs lists is "increase supervision in high-risk areas." 26

Expand their thinking. Are they really grasping how a child's ASD is playing into a bullying situation, whether the child is a victim or a bully-victim? Are the interventions proposed getting at the real issues, or are old myths and ways of thinking about bullying coloring adult responses?

If a child does act out such that he or she would usually be suspended or face other drastic action, does the school hold the required IEP meeting to determine whether the behavior was a manifestation of the child's disability?

Children with ASD have many gifts, and many challenges. Those challenges can make interaction with peers a struggle, and leave these children susceptible both to bullying and acts of self-defense that cause the school to punish the child severely. Parents, teachers, and school staff can play a proactive role by understanding the danger and intervening the moment there is a problem. The costs of bullying, to the child and to society, are just too high.